During 2005–2014, a total of 24 high school and four college football–related traumatic brain and spinal cord injury fatalities were identified, for a combined average of 2.8 fatalities per year. All four of the college deaths and 14 (58%) of the 24 high school deaths occurred during the last 5 years (2010–2014) of the 10-year study period. Most brain and spinal cord injury deaths occurred during competition, among players at running back and linebacker positions, and as a result of tackling or being tackled. Head first/head down contact was identified as contributing to eight of the 28 deaths. Four of the 22 high school players who died from brain injuries sustained a concussion within the 4 weeks prior to the event. These findings support the need for continued surveillance and safety efforts to ensure proper tackling techniques, emergency planning for severe injuries, availability of medical care onsite during competitions, and professional medical assessment that it is safe to return to play following a concussion.